Cutaneous leukocytoclastic vasculitis. Serial histopathologic evaluation demonstrates the dynamic nature of the infiltrate

Zax, Robert H.; Hodge, Steven J.; Callen, Jeffrey P.

doi:10.1001/archderm.126.1.69

Cited by 70 publications

(35 citation statements)

References 18 publications

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“…Alternatively, the virus may be more resistant to tissue clearance mechanisms. This appears less likely because in the PLI lesion, which represents an older lesion (17), elimination of HCV, IgM, and IgG from the interstitium appeared equal. On the other hand, the findings of HCV without IgM and IgG in the PLI lesion in patient 5 most likely represents HCV alone trapped in the edematous vessel wall, because inflammatory infiltrate that may alter the detection of immunoglobulins was not present.…”

Section: Discussionmentioning

confidence: 96%

Localization of hepatitis C virus in cutaneous vasculitic lesions in patients with type II cryoglobulinemia

Agnello

Ábel²

1997

Arthritis & Rheumatism

142

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Objective. To investigate the role of hepatitis C virus (HCV) in the pathogenesis of the cutaneous vasculitis in patients with type I1 cryoglobulinemia.Methods. Using in situ hybridization detection of HCV, we studied 6 test patients and various control subjects. Serum HCV was quantitated, cryoglobulins were analyzed by column chromatography at 37"C, and lowdensity lipoprotein (LDL) receptors on keratinocytes were detected using LDL labeled with fluorescent dye.Results. In the cutaneous vasculitic lesions from test patients, but not control subjects, the HCV virion was found in association with IgM and IgG. HCV alone was detected in some vessel walls, and in skin and ductal epithelium and vascular endothelium in inflamed, but not normal, skin. Cryoglobulins showed HCV, monomeric IgM, and monomeric IgG, with little or no immune complexes. The extent of the lesions correlated with levels of viremia. Up-regulation of LDL receptors on keratinocytes was detected in inflamed, but not normal, skin.Conclusion. HCV was present in the cutaneous vasculitic lesions, most likely in complexes with IgM and IgG formed in situ. These findings and the correlation of the severity of the rash with the level of viremia suggest that HCV plays a major role in the pathogenesis of cutaneous vasculitis in these patients and strength- The hallmark of type TI cryoglobulinemia is palpable purpura, a cutaneous vasculitis thought to be caused by the deposition of the components of cryoglobulins, polyclonal IgG, and monoclonal rheumatoid factor (RF) in the vessel walls (1). A strong association of hepatitis C virus (HCV) infection and type I1 cryoglobulinemia has been established (2,3), and the virus is specifically concentrated in the cryoglobulins (4). These findings suggest that HCV is the etiologic agent for the disease and that the virus may be involved in the pathogenesis of the systemic vasculitis that occurs in these patients.HCV is a single-stranded RNA virus, and both the positive strand, the putative virion RNA, and the negative strand, the putative replicative RNA, have been detected in hepatocytes of infected patients by polymerase chain reaction (PCR) assays ( 5 ) and by in situ hybridization and in situ PCR (6). HCV RNA has not been reported to be localized in cutaneous vasculitic lesions, but HCV has been detected in RNA extracted from these lesions using a PCR assay (7). However, because of the exquisite sensitivity of the PCR assay, the extraction technique does not distinguish between HCV RNA in the lesion and HCV RNA that may be present in small amounts of residual serum in unaffected blood vessels.We investigated the role of HCV in the pathogenesis of the cutaneous vasculitis in type I1 cryoglobulinemia by examining biopsy specimens of the palpable purpuric lesions from patients with type I1

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Section: Discussionmentioning

confidence: 96%

Localization of hepatitis C virus in cutaneous vasculitic lesions in patients with type II cryoglobulinemia

Agnello

Ábel²

1997

Arthritis & Rheumatism

142

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“…Pode-se observar dois padrões distintos de infiltrado celular, um predominantemente mononuclear e outro neutrofílico. Zax et al têm demonstrado uma seqüência temporal onde o infiltrado inflamatório visto nas lesões vasculíticas é predominantemente neutrofílico, e gradualmente evolui para um padrão predominantemente mononuclear 18 . Há algumas condições (como granuloma faciale e EED) caracterizadas histologicamente por VLCC que têm uma evolução crônica e não seguem esta seqüência histológica 19 .…”

Section: Discussionunclassified

Ceratólise auto-imune em paciente com vasculite leucocitoclástica: apresentação atípica de erythema elevatum diutinum com padrão granulomatoso

Casanova¹,

Meirelles²,

Tojar³

et al. 2000

Arq. Bras. Oftalmol.

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Ceratólise auto-imune em paciente com vasculite leucocitoclástica: apresentação atípica de erythema elevatum diutinum com padrão granulomatoso Contexto: A vasculite leucocitoclástica é uma doença que acomete pequenos vasos mais comumente associada a distúrbios do tecido conectivo, caracterizada clinicamente pela presença de lesões purpú-ricas palpáveis. Manifestações oftalmológicas são raras.Objetivo: Descrever quadro clínico de paciente portador de vasculite leucocitoclástica como manifestação incomum de padrão granulomatoso do erythema elevatum diutinum (EED).Relato de Caso: Paciente de 64 anos, masculino, apresentando baixa de acuidade visual e aparecimento de lesões nodulares em mãos. Ao exame oftalmológico, evidenciou-se afinamento corneano superior bilateral com perfuração corneana do olho esquerdo e espessamento da conjuntiva limbar em ambos os olhos, associada a intensa atividade inflamatória. Exame anatomopatológico da conjuntiva revelou vasculite granulomatosa com intenso exsudato neutrofílico, células gigantes multinucleadas, além de proliferação fibroblástica. Exame anatomopatológico de biopsia da pele evidenciou alterações semelhantes compatíveis com EED, porém não foi visto célula gigante sugerindo lesão granulomatosa.Conclusão: Ceratólise auto-imune secundária a vasculite leucocitoclástica cutânea (EED) não havia sido descrito na literatura, tampouco encontramos referências sobre a reação granulomatosa (encontrada na conjuntiva) em EED. Autoimmune keratolysis in a patient with leucocytoclastic vasculitis: unusual erythema elevatum diutinum with granulomatous patternUniversidade Federal de São Paulo -Escola Paulista de Medicina. INTRODUÇÃOA vasculite leucocitoclástica (VLCC), conhecida também como vasculite alérgica, angiíte por hipersensibilidade e vasculite necrotizante, é uma doença que acomete pequenos vasos (vênulas pós-capilares) mediada por imunocomplexos. É mais comumente associada a distúrbios do tecido conectivo, caracterizada clinicamente pela presença de lesões cutâneas purpúricas palpáveis mais freqüentemente localizadas nas extremidades inferiores 1 . Aproximadamente 50% dos pacientes têm envolvimento de pelo menos um órgão além da pele 2 . Os órgãos mais acometidos são rins, articulações, pulmões, cérebro e trato gastrointestinal 3 . Os achados laboratoriais mais comuns incluem alterações na velocidade de hemossedi-

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“…Chemotaxis of neutrophils leading to vessel wall injury, fi brin deposition, and erythrocyte extravasation along with fragmented neutrophils were also noted. Microscopic evaluation of the right leg infi ltrate to a mononuclear-predominant infi ltrate (7). Furthermore, drug-induced LCV is often characterized as having an eosinophilic-predominant infi ltrate (8).…”

Section: Case Presentationmentioning

confidence: 99%

Leukocytoclastic Vasculitis Drug Reaction to Certolizumab Pegol

Woody

Warren

Speck

et al. 2017

Baylor University Medical Center Proceedings

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Cutaneous leukocytoclastic vasculitis. Serial histopathologic evaluation demonstrates the dynamic nature of the infiltrate

Cited by 70 publications

References 18 publications

Localization of hepatitis C virus in cutaneous vasculitic lesions in patients with type II cryoglobulinemia

Localization of hepatitis C virus in cutaneous vasculitic lesions in patients with type II cryoglobulinemia

Ceratólise auto-imune em paciente com vasculite leucocitoclástica: apresentação atípica de erythema elevatum diutinum com padrão granulomatoso

Leukocytoclastic Vasculitis Drug Reaction to Certolizumab Pegol

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